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Research article
Takamichi Ishii
Graduate School of Medicine Kyoto University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7461-9653
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background : The bare area, which lies between the right liver and diaphragm, should be dissected to mobilize the right liver. The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure.
Methods : Surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined, changing the dissection layers of the bare area.
Results : The bare area comprised a multilayered structure that resulted in fusions in the hepatic development among the parietal peritoneum (peritoneum of the diaphragm part) and the visceral peritoneum (liver serosa). The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. Laparoscopic images sometimes enabled us to recognize the multilayered structure of the bare area.
Conclusions : Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.
Keywords
Bare area, liver, diaphragm, cadaver, Laennec’s capsule
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CURRENT STATUS: Published
View the published article at BMC Surgery.
No community comments so far
Review #1 received
Received 02 Jun, 2020
Reviewer #1 agreed
On 13 May, 2020
Reviewers invited
Invitations sent on 31 Mar, 2020
Editor assigned
On 11 Feb, 2020
Submission checks complete
On 10 Feb, 2020
Editor invited
On 10 Feb, 2020
Version 1
Posted 31 Oct, 2019
No comments provided
Editorial decision: Major revision
On 26 Jan, 2020
Reviewer #5 agreed
On 07 Jan, 2020
Review #2 received
Received 17 Nov, 2019
Review #1 received
Received 17 Nov, 2019
Review #3 received
Received 10 Nov, 2019
Review #4 received
Received 10 Nov, 2019
Reviewer #4 agreed
On 09 Nov, 2019
Reviewers invited
Invitations sent on 07 Nov, 2019
Reviewer #1 agreed
On 07 Nov, 2019
Reviewer #2 agreed
On 07 Nov, 2019
Reviewer #3 agreed
On 07 Nov, 2019
Submission checks complete
On 25 Oct, 2019
Editor assigned
On 22 Oct, 2019
Editor invited
On 21 Oct, 2019
First submitted
On 20 Oct, 2019
Metrics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Takamichi Ishii
Graduate School of Medicine Kyoto University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7461-9653
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
No community comments so far
Review #1 received
Received 02 Jun, 2020
Reviewer #1 agreed
On 13 May, 2020
Reviewers invited
Invitations sent on 31 Mar, 2020
Editor assigned
On 11 Feb, 2020
Submission checks complete
On 10 Feb, 2020
Editor invited
On 10 Feb, 2020
Version 1
Posted 31 Oct, 2019
No comments provided
Editorial decision: Major revision
On 26 Jan, 2020
Reviewer #5 agreed
On 07 Jan, 2020
Review #2 received
Received 17 Nov, 2019
Review #1 received
Received 17 Nov, 2019
Review #3 received
Received 10 Nov, 2019
Review #4 received
Received 10 Nov, 2019
Reviewer #4 agreed
On 09 Nov, 2019
Reviewers invited
Invitations sent on 07 Nov, 2019
Reviewer #1 agreed
On 07 Nov, 2019
Reviewer #2 agreed
On 07 Nov, 2019
Reviewer #3 agreed
On 07 Nov, 2019
Submission checks complete
On 25 Oct, 2019
Editor assigned
On 22 Oct, 2019
Editor invited
On 21 Oct, 2019
First submitted
On 20 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
Background : The bare area, which lies between the right liver and diaphragm, should be dissected to mobilize the right liver. The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure.
Methods : Surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined, changing the dissection layers of the bare area.
Results : The bare area comprised a multilayered structure that resulted in fusions in the hepatic development among the parietal peritoneum (peritoneum of the diaphragm part) and the visceral peritoneum (liver serosa). The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. Laparoscopic images sometimes enabled us to recognize the multilayered structure of the bare area.
Conclusions : Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
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